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Leishmaniasis

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9 Visceral Leishmaniasis (VL) In VL, amastigotes (the tissue stage of the parasite) disseminate throughout the reticuloendothelial system and occasionally are found in other organ systems. 17. The Panel recommends the collection of tissue aspirates or biopsy specimens for smears, histopathology, parasite culture, and molecular testing (S-L). 18. Bone marrow aspiration is the preferred first source of a diagnostic sample. Liver, enlarged lymph nodes, and whole blood (buffy coat) are other potential sources of tissue specimens (S-L). 19. Serum should be collected for detection of antileishmanial antibodies (see Recs. 9, 21, 22) (S-M). 20. In immunocompromised persons, blood should be collected for buffy coat examination, in vitro culture, and molecular analyses (S-VL). 21. Serologic testing is recommended for persons with suspected VL in whom definitive diagnostic tests for the parasite (microscopic identification, culture, and molecular tests for parasite DNA) cannot be conducted or have negative results (S-M). • The sensitivity and specificity of serologic tests depend on the assay and antigens used, as well as host factors. Serologic tests cannot be used to assess the response to treatment. • Antileishmanial antibodies can be detected years after clinically successful therapy in some persons. 22. The Panel suggests that tests for antileishmanial antibodies NOT be performed as the sole diagnostic assay. (W-L) • Antibodies may be undetectable or present at low levels in persons with VL who are immunocompromised because of concurrent HIV/AIDS or other reasons. The potential for false-negative test results limits the utility of serologic assays in this setting.

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